Background: Medical errors in the testing process (ordering, tracking, documentation, patient notification and follow-up) are critical problems in primary care. However, little is known about the safe performance of the testing process, especially in the smaller, independent practices prevalent in America. Candidate: As a fellowship-trained family physician, experienced in qualitative research methods, I am committed to develop novel approaches to medical error reduction that are grounded in clinical reality and informed by a human factors engineering (HFE) theoretical perspective. Career goals: Via a structured program of courses, seminars, research collaborations and work on a specific project, I will learn HFE theory and methods, acquire a background in organizational change and strengthen my quantitative analysis skills. Research goal: Use HFE techniques to understand the primary care testing process, identify tasks that are critical to safety, and organize them within a human factors model to provide the basis for developing future quality improvements. Specific Aims: 1) Identify critical safety gaps using a proposed Human Factors - Testing Process (HF-TP) Model, 2) Describe the flow of functions and tasks through a HFE study of family practice offices, 3) Revise and validate the HF-TP Model and identify functions critical to patient safety, 4) Identify barriers and promoters of future safety improvement interventions. Methods: 1) Classify existing testing process error reports within a validated human factors framework (Eindhoven) and apply the classifications to a conceptual HF-TP Model. 2) Perform a HFE task analyses at 4 diverse practices, using interviews, structured observations, surveys and review of documents to assess protocols and tasks, near misses and rrors, cognitive aids, physical environment, technology and patient input. 3) Apply the results from the HFE analysis to the HF-TP model to identify a subset of human factors categories that lead to frequent or high- risk error situations and perform additional HFE analyses at 8 - 10 practices to validate and expand the HF- TP model. 4) Conduct focus groups with participantsat the 8 - 10 practices to identify barriersand promoters of organizational change that could lead to improvements in the testing process. Benefit: The candidate will become an independent patient safety investigator,and will develop a robust human factors model of the testing process that will lead to novel approaches for effective error prevention and recovery.